Multiple band endoscopic ligation device

ABSTRACT

A multiple band endoscopic ligation device comprises a single pull string and a plurality of beads positioned on said pull string and between each successive band. The device is configured to be coupled to the distal end of an endoscope and is used to deploy multiple elastic bands around target tissues to be ligated. The device includes a tapered cylindrical body about which a plurality of elastic bands are stretched and positioned. The pull string includes multiple sets of two beads fixed to the string wherein one bead is placed directly behind and in contact with the other. The string is wrapped around the device&#39;s body and under each band such that at least one pair of beads is positioned between the elastic bands and one pair of beads is positioned proximally to the most proximal band. As the string is pulled, the beads push the bands sequentially off the distal end of the device and around a tissue to be ligated. The use of two adjacent beads on the string to push off each band ensures that the bands will not slip over the beads, thereby preventing a misfire.

CROSS-REFERENCE

The present application is a continuation application of U.S. patentapplication Ser. No. 13/680,646, entitled “Multiple Band EndoscopicLigation Device” and filed on Nov. 19, 2012.

FIELD

The present specification relates generally to the ligation of internalbody tissues. More particularly, the present specification relates to adevice for deploying multiple elastic ligating bands around targetinternal body tissues.

BACKGROUND

Ligation, as it relates to the present specification, is a medicalprocedure used to remove unwanted anatomical structures from the humanbody. Elastic or rubber band ligation involves the placement of aconstricting band about the unwanted anatomical structures, such as ablood vessel or the base or pedicle of a lesion, to occlude distal bloodsupply. After the loss of blood supply, the lesion slowly dies, sloughsoff, and is passed from the body. Elastic ligation is used in thetreatment of conditions such as internal hemorrhoids and mucous colitis.

Typical ligation procedures are performed using a ligating deviceaffixed to the distal end of an endoscope. The ligating device includesone or more elastic bands positioned on its distal end. During theprocedure, an elastic band that has been stretched outwardly beyond itsrelaxed, loop configuration is placed around the proximal portion of anoutdrawn target tissue. The band is released and thereafter naturallyconstricts back to its non-stretched configuration, thereby puttingpressure on the target tissue and cutting off blood supply to the distalportions.

U.S. Pat. No. 6,007,551, assigned to Dabegran Technologies, Inc. andCook Medical Technologies LLC, discloses “An endoscopic ligationapparatus for use with a flexible endoscope having a plurality ofchannels therethrough including a working channel opening at anauxiliary port, said apparatus comprising: a hollow barrel defining anouter surface and a hollow interior therethrough, and including a distalend and a proximal end; means for mounting said proximal end of saidbarrel to the insertion end of the flexible endoscope; at least oneelastic ligating band removably mounted on said outer surface of saidbarrel; and a trip wire configured to extend through the working channelof the endoscope and including; a proximal end and a distal end, and alength between said ends sufficient for said distal end to extend beyondthe insertion end of the endoscope while the proximal end extends fromthe auxiliary port; a plurality of strands at said distal end, each ofsaid strands extending through said hollow interior of said barrelbeyond said distal end of said barrel and overlaying said outer surfaceof said barrel underneath said at least one ligating band; and each ofsaid plurality of strands including a least one bead attached theretoand situated adjacent said at least one ligating band between said bandand said proximal end of said barrel, whereby tension applied to saidproximal end of said trip wire pulls each of said plurality of strandstoward said distal end of said barrel such that said bead on each ofsaid strands engage said at least one ligating band to dislodge saidband from said barrel, wherein said trip wire includes a bead attachedthereto adjacent said proximal end.”

U.S. Pat. No. 6,676,672, assigned to SciMed Life Systems, Inc.,discloses “A ligating band dispenser, comprising: a support surfacehaving a channel extending substantially therethrough, the supportsurface having an outer surface; and a plurality of ligating bandssupported on the outer face of the support surface; a pull lineextending through the channel and generally circumferentially along theouter surface of the support surface, the pull line having a pluralityof knots formed thereon, each of the plurality of knots having adiameter greater than a diameter of the pull line, each of the pluralityof knots being retained proximally of a corresponding one of theplurality of ligating bands, wherein the pull line loops around aselected one of the plurality of ligating bands.”

While current ligation devices have proven to be effective in removingunwanted tissues, they are not without their drawbacks. For example,ligation devices that employ more than one pull line or multiple strandsare more difficult to manufacture and use. The presence of multiplewires can also obscure vision when using the device. In addition,current multi-band ligation devices often encounter problems withdeploying all of the bands. Specifically, the bands loaded moreproximally on the device, and therefore slated to be deployed last,often misfire. When the band is stretched to the diameter of the device,the geometry of the band becomes more compliant, allowing the band tojump over the bead or knot as the line is pulled and resulting in themisfire. Misfired bands remain on the device resulting in unsuccessfultreatment of the lesion.

Therefore, what is needed is a multi-band ligation device that has animproved, more reliable deployment mechanism, particularly for theproximal bands.

SUMMARY

The present specification is directed toward an endoscopic ligationdevice for use with an endoscope having a proximal end and a distal endand a first tubular channel therebetween, said device comprising: acylindrical body having a smooth external surface, a diameter, aproximal end and a distal end and a second tubular channel therebetweenwherein said proximal end of said cylindrical body is configured tocouple to said distal end of said endoscope such that said first tubularchannel is in fluid communication with said second tubular channel; aplurality of elastic bands having a most proximal elastic band and amost distal elastic band, wherein each band is stretched beyond itsrelaxed diameter and positioned around said external surface of saidcylindrical body and further wherein said relaxed diameter of each bandis less than the diameter of said cylindrical body; and, a single pullline having a plurality of bead sets fixed along its length, whereineach of said bead sets comprises at least two beads positioned onedirectly behind and in contact with the other, further wherein said pullline has a first end and a second end and is wrapped around saidexternal surface of said cylindrical body multiple times and under saidelastic bands such that at least one set of beads is positioned betweensaid elastic bands.

In one embodiment, the first end of said pull line comprises a bead setand is positioned proximal to said most proximal elastic band and saidsecond end of said pull line passes over the distal end of saidcylindrical body, into said second tubular channel, through said firsttubular channel, and to a retracting assembly at the proximal end ofsaid endoscope. In one embodiment, the retracting assembly comprises anyone of a spooling mechanism, a linear mechanism, and a cam mechanism.

In one embodiment, the cylindrical body has a first diameter at saidproximal end and a second diameter at said distal end wherein said firstdiameter is greater than said second diameter and wherein said first andsecond diameters are greater than said relaxed diameter of said elasticbands.

In one embodiment, the beads are made of any one of glass, hard plastic,and ceramic. In one embodiment, the beads measure between 0.040 and0.060 inches in height and have a thickness of between 0.050 and 0.090inches. In one embodiment, the beads are fixed to said pull line withglue. In one embodiment, each of said plurality of elastic bands has aheight of approximately 0.040 inches. In one embodiment, said pluralityof elastic bands equals seven.

In one embodiment, the pull line passes one quarter length around theouter surface of said cylindrical body between each set of bands.

The present specification is also directed toward an endoscopic ligationdevice for use with an endoscope having a proximal end and a distal endand a first tubular channel therebetween, said device comprising: acylindrical body having a smooth external surface, a diameter, aproximal end and a distal end and a second tubular channel therebetween,wherein said proximal end of said cylindrical body is configured tocouple to said distal end of said endoscope such that said first tubularchannel is in fluid communication with said second tubular channel; aplurality of elastic bands, each band stretched beyond its relaxeddiameter and positioned around said external surface of said cylindricalbody wherein said relaxed diameter of each band is less than theexternal diameter of said cylindrical body; and, a single pull linehaving a plurality of large beads fixed along its length, wherein saidpull line has a first end and a second end and is wrapped around saidexternal surface of said cylindrical body multiple times and under saidelastic bands such that at least one bead, having a height within therange of 0.040 to 0.060 inches and a thickness within the range of 0.070to 0.140 inches, is positioned between said elastic bands.

In one embodiment, the first end of said pull line comprises a singlebead and is positioned proximal to said most proximal elastic band andsaid second end of said pull line passes over the distal end of saidcylindrical body, into said second tubular channel, through said firsttubular channel, and to a retracting assembly at the proximal end ofsaid endoscope. In one embodiment, the retracting assembly comprises anyone of a spooling mechanism, a linear mechanism, and a cam mechanism.

In one embodiment, the cylindrical body has a first diameter at saidproximal end and a second diameter at said distal end wherein said firstdiameter is greater than said second diameter and wherein said first andsecond diameters are greater than said relaxed diameter of said elasticbands.

In one embodiment, the beads are made of any one of glass, hard plastic,and ceramic. In one embodiment, the beads are fixed to said pull linewith glue. In one embodiment, each of said plurality of elastic bandshas a height of 0.040 inches. In one embodiment, the plurality ofelastic bands equals seven.

The present specification is also directed toward a method for ligatinginternal body tissues, said method comprising the steps of: providing anendoscopic ligation device for use with an endoscope having a proximalend and a distal end and a first tubular channel therebetween, saiddevice comprising: a cylindrical body having a smooth external surface,a diameter, a proximal end and a distal end and a second tubular channeltherebetween wherein said proximal end of said cylindrical body isconfigured to couple to said distal end of said endoscope such that saidfirst tubular channel is in fluid communication with said second tubularchannel; a plurality of elastic bands having a most proximal elasticband and a most distal elastic band, wherein each band stretched beyondits relaxed diameter and positioned around said external surface of saidcylindrical body and further wherein said relaxed diameter of each bandis less than the external diameter of said cylindrical body; and, asingle pull line having a plurality of bead sets fixed along its length,wherein each of said bead sets comprises at least two beads positionedone directly behind and in contact with the other, further wherein saidpull line has a first end and a second end and is wrapped around saidexternal surface of said cylindrical body multiple times and under saidelastic bands such that at least one set of beads is positioned betweensaid elastic bands; wherein said first end of said pull line comprises abead set and is positioned proximal to said most proximal elastic bandand said second end of said pull line passes over the distal end of saidcylindrical body, into said second tubular channel, through said firsttubular channel, and to a retracting assembly at the proximal end ofsaid endoscope; attaching said proximal end of said device to saiddistal end of said endoscope; inserting said distal end of saidendoscope with attached device into a patient; maneuvering said distalend of said endoscope with attached device to a target tissue; placingsaid distal end of said device over said target tissue; applying suctionto said proximal end of said endoscope to draw a portion of said targettissue into said device; and, actuating said retracting assembly toapply tension to said pull string to push the most distal bead setagainst the most distal elastic band, deploying said most distal elasticband off the distal end of said device and around said target tissue.

The present specification is also directed toward a method for ligatinginternal body tissues, said method comprising the steps of: providing anendoscopic ligation device for use with an endoscope having a proximalend and a distal end and a first tubular channel therebetween, saiddevice comprising: a cylindrical body having a smooth external surface,a diameter, a proximal end and a distal end and a second tubular channeltherebetween wherein said proximal end of said cylindrical body isconfigured to couple to said distal end of said endoscope such that saidfirst tubular channel is in fluid communication with said second tubularchannel; a plurality of elastic bands having a most proximal elasticband and a most distal elastic band, wherein each band stretched beyondits relaxed diameter and positioned around said external surface of saidcylindrical body and further wherein said relaxed diameter of each bandis less than the external diameter of said cylindrical body; and, asingle pull line having a plurality of large beads fixed along itslength, wherein said pull line has a first end and a second end and iswrapped around said external surface of said cylindrical body multipletimes and under said elastic bands such that at least one bead, having aheight within the range of 0.040 to 0.060 inches and a thickness withinthe range of 0.070 to 0.140 inches, is positioned between said elasticbands; wherein said first end of said pull line comprises a single beadand is positioned proximal to said most proximal elastic band and saidsecond end of said pull line passes over the distal end of saidcylindrical body, into said second tubular channel, through said firsttubular channel, and to a retracting assembly at the proximal end ofsaid endoscope; attaching said proximal end of said device to saiddistal end of said endoscope; inserting said distal end of saidendoscope with attached device into a patient; maneuvering said distalend of said endoscope with attached device to a target tissue; placingsaid distal end of said device over said target tissue; applying suctionto said proximal end of said endoscope to draw a portion of said targettissue into said device; and, actuating said retracting assembly toapply tension to said pull string to push the most distal bead setagainst the most distal elastic band, deploying said most distal elasticband off the distal end of said device and around said target tissue.

The aforementioned and other embodiments of the present invention shallbe described in greater depth in the drawings and detailed descriptionprovided below.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features and advantages of the present invention will befurther appreciated, as they become better understood by reference tothe detailed description when considered in connection with theaccompanying drawings:

FIG. 1 is an illustration depicting a multiple band ligation devicehaving a single string with a single bead positioned between adjacentbands, as seen in the prior art;

FIG. 2 is an illustration of a first pull string having a single beadpositioned along its length, as seen in the prior art, and of a secondpull string having two beads positioned along its length, in accordancewith one embodiment of the present specification;

FIG. 3A is an illustration depicting a multiple band ligation devicehaving a single string with two beads positioned between adjacent bands,in accordance with one embodiment of the present specification;

FIG. 3B is a side view cross sectional illustration of the multiple bandligation device of FIG. 3A;

FIG. 3C is a front view cross sectional illustration of the multipleband ligation device of FIG. 3A; and,

FIG. 4 is a flow chart illustrating the steps involved in the deploymentof ligating bands using an exemplary embodiment of the device of thepresent specification.

DETAILED DESCRIPTION

The present specification is directed toward a multiple band endoscopicligation device having a single pull string and a plurality of beadspositioned on said pull string and between each successive band. Thedevice is configured to be coupled to the distal end of an endoscope andis used to deploy multiple elastic bands around target tissues to beligated.

In one embodiment, the device of the present specification comprises acylindrical device having a distal end and a proximal end and a tubularinternal channel therebetween. In one embodiment, the proximal end ofthe device is sized and configured to fit snugly to the distal end of anendoscope. The device is attached to the endoscope by firmly pushing theproximal end of the device onto the distal end of the endoscope until asecure coupling is achieved. In another embodiment, the device includesconnecting means at its proximal end for coupling to the distal end ofthe endoscope. In one embodiment, the device is tapered from itsproximal end toward its distal end, such that the diameter of the deviceis greater at its proximal end than at its distal end. The device has asmooth external surface about which elastic ligating bands arestretched. In one embodiment, each band has squared off sides and asmooth external surface. In one embodiment, the device includes sevenindividual ligating bands.

The elastic bands are spaced evenly from each other and are individuallyencircled by a single string. The single string includes a plurality ofbeads fixed at specific positions along its length. In one embodiment,the beads are fixed to the string with glue. In one embodiment, thebeads have an oval shape and a thin profile. In various embodiments, thebeads are made of glass, hard plastic, ceramic, or any othernon-compliant material. The string is looped about the outer surface ofthe device and between each successive band such that at least two beadsare positioned between adjacent bands. In one embodiment, the stringincludes multiple sets of beads wherein the beads of each set are fixedin direct contact with one another.

A first end of the string terminates in a knot or any other fixing meansjust distal, with respect to the string, to the last set of beads. Toprepare the device, the first end of the string is held on the outersurface of the device and the most proximal elastic band is stretchedabout and loaded onto the device and on top of the string such that thefirst end of the string is positioned proximally, with respect to thedevice, to the most proximal band. The band is placed such that thebeads are positioned against the band. The most proximal elastic band isthe band that is loaded first and deployed last.

The string passes under the band and continues distally along thedevice. The string is then wrapped around the outer surface of thedevice. In one embodiment, the string is wrapped one quarter turn aroundthe device before adding the next band. The second most proximal band,with respect to the device, is then stretched and loaded onto the deviceand on top of the string such that at least one set of beads ispositioned between the most proximal band and the second most proximalband. The string is again wrapped around the outer surface of the deviceand the remaining bands are loaded distally along the device in the samefashion. After the most distal band has been loaded, a second end of thestring, opposite said first end, is extended around the distal end ofthe device, through the tubular internal channel of the device, throughthe endoscope body, and to a retracting assembly at the proximal end ofthe endoscope. In one embodiment, the retracting assembly comprises aspool configured to receive pull string slack, with attached beads, asbands are deployed. In one embodiment, the spool is attached to theproximal end of the endoscope and includes a handle whereby the operatorcan use the handle to spin the spool. Spinning the spool applies tensionto the pull string, moving the beads distally along the device andthereby deploying bands. In various embodiments, other retractingassemblies, including but not limited to, linear mechanisms and cammechanisms, are used to pull the string and deploy the bands.

Once attached to the distal end of an endoscope and fully loaded, thedevice is maneuvered by a physician to a target tissue location within apatient's body. In one embodiment, the distal end of the device isplaced about the target tissue and suction is applied to the endoscope,resulting in the target tissue being drawn into the distal end of thedevice. The physician then uses the retracting assembly to pull thesecond end of the string. Tension on the second end of the string causesthe beads positioned proximally to, with respect to the device, the mostdistal band to push the band distally along and off of the distal end ofthe device. The band encircles the tissue drawn into the device,effectively ligating said tissue. At this point, the physician maydeploy additional bands to said tissue by further pulling on the string,or, may release the suction and move on to other target tissues to beligated. In one embodiment, the physician can deploy up to sevenligating bands without having to reload the device.

In one embodiment, at least two beads are positioned, one directlybehind the other, on each segment of string between adjacent bands andproximally, with respect to the device, the most proximal band. Having asecond bead placed directly behind a first bead helps stabilize thefirst bead on the string by providing a thicker profile. Stabilizing thebeads helps the beads to maintain geometry as they are pulled againstthe band, thereby preventing the band from jumping over the beads andcausing a misfire.

In one embodiment, each bead set used to deploy an associated bandcomprises two individual beads. In another embodiment, one or more ofsaid bead sets includes two individual beads while the remaining beadsets include only one bead. For example, in an embodiment wherein thedevice includes seven ligating bands, the bead sets positionedproximally, with respect to the device, the four most proximal bands,comprise two beads each while the three most distal bead sets used todeploy the three distal bands each comprise only one bead.

In another embodiment, similar bead stabilization can be achieved byusing a single bead but by changing the geometry of the bead to make itlarger with a thicker profile. In one embodiment, the larger, singlebead has a height within a range of one and one and a half times theheight of each band and a thickness within a range of one to two timesthe thickness of an individual bead used in a two-bead embodiment.

The present specification discloses multiple embodiments. The followingdisclosure is provided in order to enable a person having ordinary skillin the art to practice the invention. Language used in thisspecification should not be interpreted as a general disavowal of anyone specific embodiment or used to limit the claims beyond the meaningof the terms used therein. The general principles defined herein may beapplied to other embodiments and applications without departing from thespirit and scope of the invention. Also, the terminology and phraseologyused is for the purpose of describing exemplary embodiments and shouldnot be considered limiting. Thus, the presently disclosed inventions areto be accorded the widest scope encompassing numerous alternatives,modifications and equivalents consistent with the principles andfeatures disclosed. For purpose of clarity, details relating totechnical material that is known in the technical fields related to theinvention have not been described in detail so as not to unnecessarilyobscure the present invention.

FIG. 1 is an illustration depicting a multiple band ligating device 100having a single string 105 with a single bead 110 positioned betweenadjacent bands 115, as seen in the prior art. The device 100 has aproximal end 101 and a distal end 102. The proximal end 101 isconfigured to attach to the distal end of an endoscope. A first end 106of the string 105 terminates in a knot or any other fixing means justproximal, with respect to the string 105, to the last bead 112. Ligatingbands 115 are deployed from the distal end 102 of the device 100 byactuating a retracting assembly which pulls on a second end of thestring 105, opposite said first end, causing the bead 110 to push themost distal band 116 off the distal end of the device 100. Successivebands 115 can be deployed by further pulling on the second end of thestring 105.

Conventional multiple band ligating devices encounter the problem ofband misfire. As the string 105 is pulled, the band 115 can slip overthe bead 110, leaving the band 115 on the device 100. Further pulling onthe string 105 would most likely result in another misfire whereinanother band 115 would remain on the device 100, or, would result in theundesired deployment of two bands 115 at once. Therefore, when such amisfire occurs, the device must be removed from the patient and reloadedor a new device must be attached to the endoscope.

FIG. 2 is an illustration of a first pull string 205 having a singlebead 210 positioned along its length, as seen in the prior art, and of asecond pull string 215 having two beads 220, 225 positioned along itslength, in accordance with one embodiment of the present specification.In the pictured embodiments, all of the beads 210, 220, 225 are ovalshaped and have a thin profile. For purposes of this specification, athin profile is defined as having a thickness no greater than 0.070inches. As discussed above, devices using a single bead pull string 205often encounter misfires wherein the elastic band jumps or slips overthe bead and remains on the device.

In accordance with one embodiment of the present specification, the pullstring 215 used to deploy bands includes two beads 220, 225 on eachsegment of string positioned between adjacent bands. In the picturedembodiment, a second bead 225 is positioned directly behind, and incontact with, a first bead 220. In the pictured embodiment, each of thebeads 220, 225 has a thickness of 0.070 inches. In one embodiment, thebeads 220, 225 are fixed to the string 215 with an adhesive. In oneembodiment, the adhesive is glue. The adhesive must be placed on thestring where the string and the bead meet (i.e. the bead center) andshould not extend beyond the thickness of the beads. Excessive ormisplaced adhesive can cause interference between the string and thebands and result in performance issues, such as band misfire. Having twobeads 220, 225 positioned one directly behind the other increases theprofile of the beads in comparison to the profile of one bead. Theprofile is increased beyond 0.070 inches but is no greater than 0.140inches. The increased thickness or profile stabilizes the beads geometryas they are pulled against the bands and prevents the bands fromslipping over the beads, thereby avoiding misfires. Having greater thantwo beads 220, 225 creates too large of a profile (i.e. a thicknessgreater than 0.140 inches) and is not advantageous for successful beaddeployment.

In another embodiment (not shown), the pull string includes one single,larger bead rather than a plurality of beads along each segment betweenadjacent bands. The larger bead has an increased thickness and thereforean increased profile as compared to single beads used in the prior art.In one embodiment, the single, larger bead has a height within the rangeof 0.040 and 0.060 inches and a thickness within the range of 0.070 and0.140 inches. Having a larger profile helps to maintain bead geometry,thereby stabilizing the bead as it is pulled against the band andpreventing the band from slipping over the bead.

FIG. 3A is an illustration depicting a multiple band ligation device 300having a single string 305 with two beads 310, 311 positioned betweenadjacent bands 315, in accordance with one embodiment of the presentspecification. In one embodiment, each bead measures between 0.040 and0.060 inches in height and has a thickness between 0.050 and 0.090inches. In one embodiment, each bead has a thickness of 0.070 inches. Inone embodiment, each band has a height of 0.040 inches. The device 300is attached at its proximal end 301 to the distal end of an endoscope. Afirst end 306 of the string 305 terminates in a knot or any other fixingmeans just proximal, with respect to the string 305, to the last pair ofbeads 312, 313. Ligating bands 315 are deployed from the distal end 302of the device 300 by actuating a retracting assembly which pulls on asecond end of the string 305, opposite said first end, causing the beads310, 311 to push the most distal band 316 off the distal end of thedevice 300. Successive bands 315 can be deployed by further pulling onthe second end of the string 305.

FIG. 3B is a side view cross sectional illustration of the multiple bandligation device 300 of FIG. 3A. In the pictured embodiment, the device300 includes seven bands 315, 316 stretched out and placed on the devicebody 307. Segments of pull string 305 can be seen wrapped around thedevice body 307 between adjacent bands 315. Bead 313 of the mostproximal, with respect to the device 300, bead set is positionedproximally to the most proximal band 316. Also depicted are beads 311 ofthe second most and third most proximal, with respect to the device 300,bead sets. The pull string 305 passes through the center of each bead311, 313. Additional bead sets are positioned between the remainingadjacent bands 315 but are offset from those discussed and as such arenot pictured in this view.

The distal end 302 of the device 300 comprises an opening for placementover the target tissue. In one embodiment, the proximal end 301 of thedevice is sized and configured to fit snugly over the distal end of anendoscope 320. In another embodiment, the proximal end 301 of the device300 includes a means 318 for coupling the proximal end 301 of the device300 to the distal end of the endoscope 320. In one embodiment, thecoupling means 318 includes a flexible adapter that fits over the distalend of the endoscope and is fixed to the proximal end 301 of the device300.

FIG. 3C is a front view cross sectional illustration of the multipleband ligation device 300 of FIG. 3A. As discussed, the device 300comprises a cylindrical body 307 with a hollow center channel 309. Asingle pull string 305 and seven bands 315 are wrapped about the device300. The pull string 305 includes a plurality of bead sets along itslength. FIG. 3C represents a cross sectional slice through thecylindrical body 307, the pull string 305, and a pair of beads 310, 311of one bead set when viewed from the front. As such, for purposes of theillustration, the distal end of the device 300 would extend outward fromthe plane of the figure and toward the reader and the proximal end ofthe device would extend inward from the plane of the figure and awayfrom the reader.

Point 305 a represents the position where the pull string 305 emergesfrom under the next most proximal band 315. The pull string 305 iswrapped tightly around the outer surface of the cylindrical body 307until it reaches the bead set 310, 311. At point 305 b, the pull string305 is lifted slightly off the cylindrical body 307 and passes throughthe center of the beads 310, 311. The pull string 305 is fixed to thebeads 310, 311 where it passes through the beads 310, 311 centers. Atpoint 305 c, after emerging from bead 310, the pull string 305 extendsdistally along the device 300 and under the next most distal band (notshown). The pull string continues in the same manner distally around thecylindrical body 307 and under each remaining band with a bead setbetween adjacent bands. After passing under the most distal band, thepull string 305 wraps over the distal end of the cylindrical body 307and extends proximally through the device center channel 309, asdepicted at point 305 d. The pull string 305 continues proximallythrough the center channel of the endoscope to a retracting assembly atthe proximal end of the endoscope.

FIG. 4 is a flow chart illustrating the steps involved in the deploymentof ligating bands using an exemplary embodiment of the device of thepresent specification. At step 402, a multiple band endoscopic ligationdevice as described in the present specification is attached to thedistal end of an endoscope. The distal end of the endoscope and theattached device are then inserted into a patient and maneuvered to atarget tissue at step 404. At step 406, the distal end of the device isplaced over the tissue to be ligated. Suction is applied to the proximalend of the endoscope at step 408 to draw a portion of the target tissueinto the device. Then, at step 410, a user actuates a retractingassembly on the proximal end of the endoscope which results in tensionbeing applied to the device's pull string. Tension on the pull stringcauses the most distal beads to push the most distal band off of thedistal end of the device and around the target tissue. If the physicianwishes to apply more ligating bands to the target tissue, then thedeployment procedure of step 410 is repeated.

Suction is then removed from the endoscope and the ligated target tissueis released from the distal end of the device at step 412. If there aremore target tissues within the patient and the device still has bandsavailable, then the distal end of the endoscope and the attached deviceare maneuvered to another target tissue at step 414. The user thenrepeats steps 406 through 412 to ligate the remaining target tissues.Once no other tissues remain to be ligated, the distal end of theendoscope and the attached device are removed from the patient at step416.

Exemplary Case Study

A multiple band endoscopic ligation device with a single pull stringhaving only one bead to deploy each band, as seen in the prior art, wastested against a multiple band endoscopic ligation device with a singlepull string having two beads to deploy each band, in accordance with oneembodiment of the present specification. Each device comprised six bandsand the rate of successful band deployment for each band was measuredfor both devices. Table 1 lists the successful band deployment rates forthe two devices.

TABLE 1 Successful Band Deployment Rates Device having one Device havingtwo bead for deployment beads for deployment Band Number Success BandNumber Success (Most Distal Rate (95% (Most Distal Rate (95% on DeviceConfidence on Device Confidence First) Interval) First) Interval) FirstBand 91% First Band 91% Second Band 91% Second Band 91% Third Band 91%Third Band 91% Fourth Band 85% Fourth Band 91% Fifth Band 85% Fifth Band91% Sixth Band 76% Sixth Band 91%

As can be seen in Table 1, the two devices had the same success rate,91% at the 95% confidence interval, for the first three, or most distalthree, with respect to the device, ligation bands. However, startingwith the fourth most distal band, the success rate for the single beaddevice began to decline, dropping to 85%, signifying more misfires,while the success rate for the two bead device remained at 91% at the95% confidence interval. The success rates for the fifth band were again85% and 91% for the single bead device and two bead device,respectively. The single bead device encountered the highest rate offailure with the sixth band, having only a 76% successful deploymentrate at the 95% confidence interval while the success rate for the twobead device again remained at 91%. Hence, the use of a pull string withtwo beads for pushing bands off the device increases the likelihood ofsuccessful band deployment over a device using a pull string with onlyone bead, particularly with respect to the bands positioned moreproximally on the device. To achieve the same success rates, one canhave an embodiment with the first three bands having associatedtherewith a single bead and the next three bands having associatedtherewith two beads. Alternatively, some subset of the bands can have asingle bead while the remainder can have two beads.

The above examples are merely illustrative of the many applications ofthe system of the present invention. Although only a few embodiments ofthe present invention have been described herein, it should beunderstood that the present invention might be embodied in many otherspecific forms without departing from the spirit or scope of theinvention. Therefore, the present examples and embodiments are to beconsidered as illustrative and not restrictive, and the invention may bemodified within the scope of the appended claims.

I claim:
 1. A method for ligating internal body tissues, said methodcomprising the steps of: providing an endoscopic ligation device for usewith an endoscope having a proximal end and a distal end and a firsttubular channel therebetween, said device comprising: a cylindrical bodyhaving a smooth external surface, a diameter, a proximal end and adistal end and a second tubular channel therebetween wherein saidproximal end of said cylindrical body is configured to couple to saiddistal end of said endoscope; a plurality of elastic bands having a mostproximal elastic band and a most distal elastic band, wherein each bandstretched beyond its relaxed diameter and positioned around saidexternal surface of said cylindrical body and further wherein saidrelaxed diameter of each band is less than the external diameter of saidcylindrical body; and, a single pull line having a plurality of beadsets fixed along its length, wherein each of said bead sets comprises atleast two beads positioned one directly in contact with the other,further wherein said pull line has a first end and a second end and iswrapped around said external surface of said cylindrical body multipletimes and under said elastic bands such that at least one set of beadsis positioned between said elastic bands; wherein said first end of saidpull line comprises a bead set and is positioned proximal to said mostproximal elastic band and said second end of said pull line is attachedto a retracting assembly at the proximal end of said endoscope;attaching said proximal end of said device to said distal end of saidendoscope; inserting said distal end of said endoscope with attacheddevice into a patient; maneuvering said distal end of said endoscopewith attached device to a target tissue; placing said distal end of saiddevice over said target tissue; applying suction to said proximal end ofsaid endoscope to draw a portion of said target tissue into said device;and, actuating said retracting assembly to apply tension to said pullstring to push a most distal bead set against a most distal elasticband, deploying said most distal elastic band off the distal end of saiddevice and around said target tissue.
 2. The method for ligatinginternal body tissues of claim 1, wherein said proximal end of saidcylindrical body is configured to couple to said distal end of saidendoscope such that said first tubular channel is in fluid communicationwith said second tubular channel.
 3. The method for ligating internalbody tissues of claim 2, wherein said first end of said pull linecomprises a bead set and is positioned proximal to said most proximalelastic band and said second end of said pull line passes over thedistal end of said cylindrical body, into said second tubular channel,through said first tubular channel, and to the retracting assembly atthe proximal end of said endoscope.
 4. The method for ligating internalbody tissues of claim 1, wherein said retracting assembly comprises anyone of a spooling mechanism, a linear mechanism, and a cam mechanism. 5.The method for ligating internal body tissues of claim 1, wherein saidcylindrical body has a first diameter at said proximal end and a seconddiameter at said distal end wherein said first diameter is greater thansaid second diameter and wherein said first and second diameters aregreater than said relaxed diameter of said elastic bands.
 6. The methodfor ligating internal body tissues of claim 1, wherein said beads aremade of a material and wherein said material comprises at least one ofglass, hard plastic, and ceramic.
 7. The method for ligating internalbody tissues of claim 1, wherein each of said beads measures between0.040 and 0.060 inches in height and has a thickness of between 0.050and 0.090 inches.
 8. The method for ligating internal body tissues ofclaim 1, wherein each of said plurality of elastic bands has a height ofapproximately 0.040 inches.
 9. The method for ligating internal bodytissues of claim 1, wherein said beads are fixed to said pull line withglue.
 10. The method for ligating internal body tissues of claim 1wherein said plurality of elastic bands equals seven.
 11. The method forligating internal body tissues of claim 1 wherein said pull line passesone quarter length around the outer surface of said cylindrical bodybetween each set of bands.
 12. The method for ligating internal bodytissues of claim 1 further comprising a flexible adapter configured tofit over the distal end of the endoscope, wherein said proximal end ofsaid cylindrical body attaches the flexible adapter in order couple tosaid distal end of said endoscope.
 13. The method for ligating internalbody tissues of claim 1 further comprising: maneuvering said distal endof said endoscope with attached device to a second target tissue;placing said distal end of said device over said second target tissue;applying suction to said proximal end of said endoscope to draw aportion of said second target tissue into said device; and, actuatingsaid retracting assembly to apply tension to said pull string to push asecond most distal bead set against a second most distal elastic band,deploying said second most distal elastic band off the distal end ofsaid device and around said second target tissue.
 14. The method forligating internal body tissues of claim 1 wherein a success rate fordeploying said most distal elastic band is equal to a success rate fordeploying a most proximal elastic band.
 15. The method for ligatinginternal body tissues of claim 1 wherein a success rate for deploying amost distal elastic band is equal to a success rate for deploying asecond most proximal elastic band.
 16. The method for ligating internalbody tissues of claim 1 wherein a success rate for deploying a secondmost distal elastic band is equal to a success rate for deploying a mostproximal elastic band.
 17. The method for ligating internal body tissuesof claim 1 wherein a success rate for deploying a second most distalelastic band is equal to a success rate for deploying a second mostproximal elastic band.
 18. The method for ligating internal body tissuesof claim 1 wherein a deployment success rate is equal for all elasticbands.